weekend wrap-up

We decided to take it easy this weekend and stay in the greater Guadalajara area.

Saturday we met up with one of our new friends and went to the movies.  This wasn't just any movie, this was VIP.  For less than a regular movie ticket back at home, you get to sit in a very comfortable leather recliner chair and have food and drink brought to you.  Yes, it's pretty awesome.  We watched Pirates of the Caribbean while enjoying cold beer, popcorn with chile, and sushi in an air conditioned theater.  Wonderfully cold air conditioning, it's really the little things I miss.  :)

Best movie theater ever

Anyways, also at this pretty hoity toity mall we discovered a few more additional treats.  We ordered crepes the size of our head.  One was filled with nutella, strawberries and banana.  The other with bananas, almonds, and cajeta (aka caramel of sorts).  Claire and I also decided to feed our coffee addiction so we tried out a new coffee shop at this fancy mall called Black Coffee Gallery.  After drinking many weak attempts at americanos, iced coffees, lattes, and iced lattes, I was stunned when I was able to order two iced soy lattes with ice cubes, not blended, and without sugar.  I had no idea how much I missed a good iced latte and this one was so refreshing and so needed.  I know, I'm addicted.

Crepe con cajeta

In Spanish, my name becomes one of three things: Liz, Lizbet, and Isabel (Isabel is often the easiest)

I promise I did more than eat all day long.  (However, you do have to remember I am walking at least 4 miles a day and running 3 miles every Monday, Wednesday and Friday.)  After the movie, we headed to Av. Chapultepec.  It's one of the larger streets in the city that gets shut down for a few hours every Saturday night.  The street is filled with artisans, vendors, and music.  We had a lot of fun walking around and feeling like locals. 


The next day we headed to Tonala.  Every Thursday and Sunday, the place turns into a giant flee market.  There was so much stuff.  Vendor after vendor with tables full of ceramics, jewelry, fabrics, toys, kitchenware, furniture, and much much more.  I bought a set of glasses and a condiment plate.  For lunch, we again followed the cardinal rule of street food, and looked for a busy place with steaming hot food.  We stumbled upon a stand and ordered sopes, tortas, and flautas filled with spicy, stewy, tomato based beef.  The sopes were made right in front of us.  The lady flattened out the dough, threw it in the fryer, took it out to shape it again using what I'm sure are very callused fingers, and finished cooking the dough.  Again, I couldn't have asked for a better meal.  However, you can see what I'm talking about when I say I play Russian Roulette with my food.  But, how can you not trust someone like this frying your food in front of you? 

Claire's torta

 We finished lunch with churros fresh from the fryer.  How fresh you ask?

  
One of the highlights of the trip was talking to the taxi drivers that took us to and from Tonala.  I learned a lot about where to travel in the area, the differences between local towns, the economic frustrations of the people of Guadalajara, and the difficulty of learning new languages.  It's safe to assume my Spanish has improved. 

For dinner we hit up an Argentinian restaurant called Savora.  We had pepitos (aka sandwiches) filled with a large cut of rib eye.  Yum.  Dessert was the Ferrero Roucher ice cream completing another wonderful day in Mexico.  

This picture does not do the ice cream justice

Amoebas Amigas

Since I've been in Mexico, I've felt a little off.  It was never bad enough to stop me from doing anything, but it's been a nuisance.  Finally after an abdominal cramp that prevented me from finishing our morning 30 minute run, I decided it was time to talk to the doctor that Claire and I work with at clinic.  Following a brief history and targeted abdominal exam, she told me I had amoebas.  Immediately, we all started joking about the amoebas amigas en mi estomago.  The doctor did a little dance and we laughed about the antro (aka dance club) in my stomach.  She told me not to worry and how could I when I left the doctor thinking about dancing amoebas amigas in my stomach.  Not gonna lie, those amoebas picked a pretty tasty GI tract to hang out in.

Honestly, I find it pretty hilarious.  If you know me at all, you know that I love parasites and almost all things microbiology.  Combined with a continual game of chance that I play with my meals, it was bound to happen sooner or later.

Being a medical student, of course I'm going to think about everything it could be.  On my differential are Entamoeba Histolytica and Giardia Intestinalis.  However, it doesn't really matter what it is.  I have parasites.

So, today begins my 3 day bid regimen of a lovely anti-protozoal agent, Nitazoxanide.  Here's to hoping the drug doesn't kill me before the amoebas. 

Week 2 in Guadalajara

This week went by so quickly, but it was a pretty great week.  Here's why:

In clinic, we all got to be practice patients for the national student's clinical exams.  Their exams are incredibly thorough.  I was examined for lice, checked for sinus pain and congestion, and had my lungs listened to at least 30 times.  I'd like to add that it is not an easy thing for a non-native Spanish speaker to repeat "perro" (the equivalent of our ninety-nine) 20 times while rolling their r's.  The exam also pointed out some significant differences between a country like America, and a country like Mexico.  In addition to being checked for lice, I was also asked a lot more questions about the services (gas, light, water, etc) at my house, how many people are living there, as well as childhood infectious diseases that we are all vaccinated for.  Overall, it was a great experience because it gave me the opportunity to listen to and learn from a well-executed and thorough history and physical exam.


I also had the opportunity to talk to the doctors about the health care system in Mexico and the training of young physicians.  One of the interesting things they discussed was the inability of new medical students to listen to the patient and diagnose by touch and physical exam.  There are copious amounts of information out there and we are so focused on questions and answers that we forget about the patient in front of us.  Watching our doctor with patients has been great because we see how a doctor should interact with their patients.  She never interrupts them, and she watches and studies her patients very closely.  A recent patient came in with abdominal pain and our doctor diagnosed her mostly on the way the patient sat up and laid down on the exam table.  If I've learned anything it's that I still have a long road ahead of me and a lot left to learn.

Despite our 9-9 days, Claire, Kasey and I still managed to have fit in a lot of fun and cultural activities.  Wednesday night we went out with some of our favorite UAG medical students.  We went to a Cuban restaurant called La Bodeguita del Medio.  We met up at 11pm to enjoy good conversation, tasty mojitos, and delicious food.

Thursday afternoon, we went on a little adventure with some of our classmates.  Instead of taking the bus, we thought we would walk the mile and a half to the other UAG campus, meet up with some of our same friends, and then walk together to Tortas Tono.  Our mile and a half walk failed and it took us over an hour to get to our destination.  We walked and walked and walked, then asked a 12 year old for directions, walked some more, asked a few police officers where to go, flagged down a taxi, piled 5 girls in to the back seat of a teeny tiny car, and finally arrived.  Now, had these been bad tortas ahogadas, we would have all gone to clinic in a very bad mood.  Fortunately, these were ridiculously delicious.  The bread had a crunchy exterior and soft interior, perfect to soak up all the spicy tomato sauce.  It was filled with well seasoned and tenderly cooked meat (pierna) and covered in sliced onions, cabbage, and lime juice.  The perfect combination of textures and flavors was all we needed to lift our spirits.  The afternoon was completed by a trip to the local pastry store, Marisa, where we bought some gelatin treats and chocolate cake for later that night.

To end our busy week, Friday night we went out with one of our roommates and her friends to a local bar.  The drink of the night, tequila.  We attempted conversations with an interesting mix of English and Spanish and danced the night away.  Drinking, dancing, and having fun are three things no language barrier can get in the way of.

22 bug bites and counting

I'm pretty sure I'm gonna get Dengue.  Stupid mosquitoes.

Sunday's mission: acquire tortas ahogadas

We decided to visit Guadalajara's historic city center on Sunday.  Yes, we were there to look at the Catedral, Palacio de Gobierno, Teatro Degollado, and numerous tree lined plazas.  But let's be honest, I was there to rome the bustling markets.

Every time I travel, I am always mesmerized by the central markets.  They are filled with fresh, colorful produce, butchers, fish vendors, small family-owned eateries, and tons of locals.  A market like that is the heart of a city.  During our day trip, we visited two markets: Mercado Corona and Mercado San Juan de Dios.

At Mercado Corona, we explored the rows of herbs and natural remedies.  They had something for every ailment.  I'm a big believer in natural and home remedies for common, everyday illnesses.  It may just be a placebo effect, but if it works it works.  As a physician, it's even more important to know about these alternative treatments because most patients are using them and I'll need to know if they interfere with their Western medical treatment.  For example, St. John's wort can interfere with many different prescription drugs, including oral contraceptives.  Not a good idea. 

I hate that we don't have central markets back at home.  Our food would be tastier and healthier.  More importantly, people would be healthier.  There is an overabundance of research detailing the benefits of farmer's markets for hypertension, diabetes, obesity, and hyperlipidemia (aka hyperdiabesidemia).  And, how much fun would it be to shop in a place like this every day?

Finally, after hours of taking pictures, wandering the streets of Guadalajara, and exploring the markets, we wandered to the second floor of Mercado San Juan de Dios.  The goal was to find the cleanest and busiest eatery in order to prevent any unwanted intestinal colonization of parasites or bacteria.  After scoping out all the little eateries, we settled on Tortas Mario.  As usual, we each ordered the same delicious meal.  This time it was tortas ahogadas, one of Guadalajara's specialties.  It's a meat filled sandwich soaked/drowned in a spicy vinegary broth.  As Claire said, it's the Mexican version of a French dip.  Topped with onions and a sprinkle of lime, it was g-o-o-d.  Mission accomplished. 

one tequila, two tequila, three tequila, floor?

Alright.  We didn't actually have THAT much tequila in Tequila, but we did have a generous serving of the Jalisco region's prized product at Mundo Cuervo, the Jose Cuervo Distillery.  We visited the region with some of our fellow medical Spanish classmates and had a really great day.


The drive itself was long, but full of photo worthy scenery.  The land was covered in blue agave and was a sight to see.

Upon arrival, we walked around the beautiful little town.  We strolled through the outdoor market, snapped photos in front of the cathedral, and wandered around the Cuervo distillery.

 

For lunch, we visited the town's central market, complete with several different eateries ready to be enjoyed.  Earlier, I had asked someone which place was their favorite and he pointed us to Conchome.  For lunch we had meat marinated in tequila that we wrapped in fresh tortillas.  How fresh you ask?

Here is the lady making the tortillas just across the market.

And here are the tortillas on our table.

After lunch, it was time for our tour.  Tequila is made from the blue agave plant.  After taking off the leaves, you are left with a "pineapple" which is pressed to remove the juice.  The left over fibers are recycled into cookies and paper.  The foodie in me wondered how the same ingredient that can make paper can also make tasty cookies.  So of course I bought them at the store and will let you know when I find out. 

 
Back to the tequila.  The liquid is then processed into alcohol.  The first batch produced is 55% alc. vol.  The distillery isn't allowed to sell it, but they were allowed to let us taste it.  As one could imagine, it tasted like rubbing alcohol and left that warm burn in my throat.  We continued to learn about the aging process and resulting 35% alc. vol.  Blanco is aged a few days in oak barrels, Reposado a few months, and Anejo a few years giving them progressively more complex and smoother flavors.  The highlight of the tour was learning to taste tequila.  First, you swirl the tequila in the glass a few times and look for drops to form and drip down the glass.  This lets you know the tequila is safe to drink.  Then you tilt the glass and smell the tequila at the bottom, middle, and top of the glass.  Finally, you taste. But it's not ordinary taste.  You breath in through your nose, take a sip, hold it in your mouth 4-5 seconds, swallow, and then breath out through your mouth.  Pretty cool.

After all that learning, we called it a day with margaritas on the patio before heading back to Guadalajara. 

making friends at clinic

At clinic this week, Claire and I had the chance to get two know some awesome UAG medical students.  Here's a photo of us after eating some delicious tacos, gringas, and quesadillas at Tacos Nortenos.  Dinner was filled with spicy salsa and more yummy grilled meat.  You can't go wrong with a fresh tortilla, grilled asada, chopped onions and cilantro, and a drizzle of spicy salsa. 

We followed the deliciousness with ice cream made from ferrero roucher chocolates.  Two scoops of rich chocolate ice cream with plenty of chocolate and hazelnut pieces was a great way to end our first week of clinic.

El dolor de estomago

Today, I finally had that moment we've all known was coming where I realized how much I've actually learned this past year.  There was no big "ah, ha"; medicine just seemed natural.  Claire and I were at clinic today, watching the UAG medical students fumble through a patient history.  The patient was a 22 year old female coming in with stomach pain.  As she's describing her symptoms, I'm trying to pick up as much of the language as possible.  Finally, I watch her move her hands from the center of her abdomen to her right side as she describes how the pain has moved since it first began.  Immediately, I knew it was an appendicitis.

We followed her into the doctor's office and listened to the patient answer more questions.  Upon physical exam, the doctor touched an area of her abdomen referred to as McBurney's point.  The patient cried out in pain.  The doctor then bent the patient's right leg, and the diagnosis was confirmed.  She had an appendicitis and needed to immediately go to the hospital.

After the patient left, the doctor asked us for a differential diagnosis.  What else could have been wrong with this patient?  As we stumbled through our differential in Spanish, I didn't care that we were failing miserably.  What mattered was that I finally realized and appreciated how much I've learned this past year.  I know how to take a history, I know how to do a physical exam, I can present patients to doctors, and I can synthesize symptoms into a classical diagnosis.  Amazing.

There is more to this stomach ache story.  Some would consider it a sin, but I have been in Mexico one week and had not eaten tacos.  So, what was I going to do?  Skip the provided lunch with the host family and find me some tacos.  Now, none of us actually got a stomach ache, but upon eating 6 tacos each, the potential for stomach aches was there.  Deliciously fresh tortillas, several different meats (chorizo, carnaza, pastor, asada y lengua), onions, cilantro, a few salsas, and an ice cold manzanita later, I was a happy girl.

 ...clearly, we all were.   

Estoy en Mexico!!

That's right.  I'm in Guadalajara taking a medical Spanish course at UAG.  I've only been here for 6 days but I've already learned so much (it's actually really hard not to write this post in Spanish seeing as how I'm thinking of the words in Spanish but typing in English). 

I came here with two of my good friends from medical school, Kasey and Claire, and we are having a wonderful time.  We arrived on Thursday and were already on a bus headed to Puerto Vallarta on Friday.  I can never say no to some quality beach time. 

Mis amigas y yo

Now since this is supposed to be a food related blog, it's important I talk about our meals in PV.  What were some of our first meals in Mexico? 

Chilaquiles with eggs (aka tortilla chips drowned in salsa, cheese and cream) with a cup of oh so fresh coffee.

Mole.  Need I say more?

A refreshing beach snack of mangos and jicama with chile and limes.

You are probably thinking yum (or que rico depending on your current location) and you would be correct.  Even though we were in a bit of a rush to get to PV, we couldn't have asked for a better weekend.  The weather was perfect, the sun was shining, and the ocean was inviting.  We got some of our first cat calls while walking along the boardwalk.  A few favorites of ours were "Hola Charlie's Angels" and "Do you need three Mexican Body Guards?"  Our trip quickly came to an end so our last night in PV, we watched the sun set while enjoying margaritas on a patio overlooking the ocean.  Life is tough...

I promise I came to Guadalajara to study Spanish.  I'm taking intermediate grammar and medical Spanish courses for four hours every day.  The classes are incredibly fast paced but the teachers are amazing!  By the end of the program, it's pretty realistic to say that I will be able to do an entire history, exam, and assessment in Spanish.  After class, we walk back to our house for lunch.  Lunch is quite the event here since it is the most important meal of the day.  It's not unusual to have three courses, all washed down with aguas frescas.  All of our weekday meals are prepared by Marisol who is essentially the woman who runs the entire household.  There are 5 students staying here and she certainly has her hands full, but her meals never disappoint.  Everyone speaks Spanish and are continually patient as we learn to speak (and understand) Spanish. 

After lunch, we rush back to campus so we can catch our rides to clinic.  Claire and I are at the same clinic.  We've only seen a few patients so far, but it's been fun listening to the patients describe their symptoms and watching the doctor interact with her patients.  Medicine is more casual and friendly here.  The patient is seen in the doctor's office, complete with the doctor's desk and examining table.  Our doctor teaches UAG medical students and seems excited to start working with us.  Next week the UAG medical students will no longer be at clinic and our doctor is going to be relying on us to complete patient intake. 
 
This weekend we plan on exploring downtown Guadalajara, hunting down tortas ahogadas, and going on a tequila tasting tour.  It's going to be an awesome few weeks.  Adios!!